Addictive behaviors represent confusing and complex
patterns of human activity (Shaffer, 1996, 1997). These behaviors include
drug and alcohol abuse, some eating disorders, compulsive or pathological
gambling, excessive sexual behaviors, and other intemperate behavior
patterns. These behaviors have defied explanation throughout history. In
this essay, I will attempt to clarify the nature of addiction and provide an
introduction to the field of addictive behaviors.

The field of addictions rests upon a variety of
disciplines. Medicine, psychology, psychiatry, chemistry, physiology, law,
political science, sociology, biology and witchcraft have all influenced our
understanding of addictive behavior. Most recently, biological explanations
of addiction have become popular. These approaches seek to understand
alcoholism, for example, by identifying the genetic and neurochemical causes
of this problem. It is interesting to recognize that as we understand more
about the biology of addiction, social and cultural influences become
morenot lessimportant. To illustrate, not everyone who is predisposed
genetically to alcoholism develops the disorder. Some people who are not
prone bio-genetically to alcoholism or other addictions will acquire the
condition. Therefore, social and psychological forces will remain very
important in determining who does and who does not develop addictive
behaviors.

Now it is common to think of drugs as "addictive."
Warning labels inform us that tobacco is an addictive substance. We think of
heroin and cocaine as addictive. Yet, addiction is not simply a property of
drugs, though drugs are highly correlated with addiction. Addiction results
from the relationship between a person and the object of their addiction.
Drugs certainly have the capacity to produce physical dependence and an
abstinence syndrome (e.g., neuroadaptation). New evidence suggests that
neuroadaptation also results from addictive behaviors that do not require
ingesting psychoactive substances (e.g., gambling).

Altlhough neuroadaptation (i.e., tolerance and
withdrawal) can result from a variety of repetitive behaviors, neuroadaption
is not the same as addiction. If neuroadaptation and its common
manifestation of physical dependence were the same as addiction, then it
would be incorrect to consider pathological gambling as an addictive
behavior. It would be inaccurate to talk about sex and love addicts. Many
people who use narcotics as post-operative pain medications never display
addictive behavior even though they have became dependent physically on
these psychoactive substances. Stopping drug abuse will not end addiction,
since addictive behavior patterns (e.g., gambling) can exist in the absence
of drug abuse. Addiction is not simply a qualitative shift in experience, it
is a quantitative change in behavior patterns: things that once had priority
become less important and less frequent behaviors become dominant. Addiction
represents an intemperate relationship with an activity that has adverse
biological, social, or psychological consequences for the person engaging in
these behaviors.

Scientists and treatment providers are not the only ones
with a problem when the meaning of addiction is fuzzy. The average citizen
will find that, without a clear definition of addiction, the distinctions
among an array of human characteristics (e.g., interest, dedication,
attention to detail, craving, obsession, compulsion and addiction) will
remain blurred. Finally, the contemporary conceptual chaos surrounding
addiction must be resolved to clarify the similarities and differencesif
these existbetween process or activity addictions (e.g., pathological
gambling, excessive sexual behavior) and psychoactive substance using
addictions (e.g., heroin or alcohol) (Shaffer, 1997).

Paradigms Serve Both Organizing and Blinding
Functions

In response to my preceding comments, some clinicians,
researchers and policy makers may argue that they indeed have an explicit
definition of addiction. Since these individuals have a model, they
incorrectly assume that they also have the truth; they assume that their
model is accurate. In addition, they incorrectly assume that their model
will work for the rest of us if only we could see the light (cf., Shaffer,
1994). However, this is the problem with worldviews in general and
scientific paradigms (Kuhn, 1962) in particular: as a conceptual schema
organizes one persons thoughts, simultaneously, it blinds that person to
alternative considerations (Shaffer & Gambino, 1983). Rigid thinking sets in
and science fails to progress until anomalies challenge the conventional
wisdom.

Distinctions Among Use, Abuse, Dependence, and
Addiction

Absent a consensual definition of addiction, clinicians
and social policy makers often are left to debate whether patients who use
drugs also "abuse" drugs. Treatment programs regularly mistake drug users
and "abusers" for those who are drug dependent. Too often the result is
unnecessary hospitalization, increased medical costs, and patients who learn
to distrust health care providers; alternatively, absent a precise
definition of addiction, some patients fail to receive the care they
require. As a result of these complex conditions, practice guidelines in the
addictions are equivocal and health care systems experience management and
reimbursement chaos. [Although a full discussion of this matter is beyond
the scope of this essay, it also is important to note that not all people
with addiction are impaired in every aspect of their daily life. Despite
some exceptions, substance addictions tend to be more broad-spectrum
disorders while pathological gambling tends to be a more narrow-spectrum
disorder.]

Even under most established constructions of addiction,
not all drug dependent patients evidence addictive behavior. For example, in
most civilized countries, under nearly all traditional circumstances, people
who are nicotine dependent do not evidence addiction with its attendant
anti-social behavior pattern. When tobacco is recast as a socially or
legally illicit substance, however, these antisocial aspects of addictive
behavior have emerged (e.g., Reuters News Service, 1992).

Complicating matters, neuroadaptation and physical
dependence can emerge even in the absence of psychoactive drug use. For
example, upon stopping, pathological gamblers who do not use alcohol or
other psychoactive drugs often reveal physical symptoms that appear to be
very similar to either narcotics, stimulants, or poly-substance withdrawal
(e.g., Shaffer, Hall, Walsh, & Vander Bilt; 1995; Wray & Dickerson, 1981).
Perhaps repetitive and excessive patterns of emotionally stirring
experiences are more important in determining whether addiction emerges than
does the object of these acts.

Addiction with Dependence and Without Dependence:
Substances and Process

If addiction can exist with or without physical
dependence, then the concept of addiction must be sufficiently broad to
include human predicaments that are related to both substances and
activities (i.e., process addictions). Although it is possible to debate
whether we should include substance or process addictions within the kingdom
of addiction, technically there is little choice. Just as the use of
exogenous substances precipitate impostor molecules vying for receptor sites
within the brain, human activities stimulate naturally occurring
neurotransmitters (e.g., Hyman, 1994; Hyman & Nestler, 1993; Milkman &
Sunderwirth, 1987). The activity of these naturally occurring psychoactive
substances likely will be determined as important mediators of many process
addictions.

The Neurochemistry of Addiction: Shifting Subjective
States

We may be able to advance the field by considering the
objects of addiction to be those things that reliably and robustly shift
subjective experience. The most reliable, fast-acting and robust "shifters"
hold the greatest potential to stimulate the development of addictive
disorders. In addition, the strength and consistency of these activities to
shift subjective states vary across individuals. Currently, we cannot
predict with precision who will become addicted. Nevertheless, psychoactive
drugs and certain other activities like gambling, exercising, and meditating
will correlate highly with shifting subjective states because these
activities reliably influence experienceand therefore neurochemistry.
Consequently, psychoactive drug use and other activities (e.g., gambling)
that can potently and reliably influence subjective state shifts will tend
to be ranked high among the full range of activities that can associate with
addictive behaviors.

Objects of Addiction: Cause, Consequence, or
Relationship

To this point, I have implied tacitly that simply using
drugs or engaging in certain activities do not cause addiction. Now let me
be explicit: from a logical perspective, the objects of addiction are not
the sole cause of addictive behavior patterns. The teleological aspects of
addiction theory and practice contribute much to contemporary conceptual
chaos. If drug using were the necessary and sufficient cause of addiction,
then addiction would occur every time drug using was present. Similarly, if
drug using was the only cause of addiction, addictive behaviors would be
absent every time drug using was missing. However, as I described before,
neuroadaptation and pathological gambling are often present when drug using
is absent. Therefore, either drug using is not a necessary and sufficient
cause to produce addiction or gambling disorders are not representative of
addictive behaviors. Furthermore, using psychoactive drugs may not be a
primary cause of addiction. Even though drug using is highly correlated with
addictionbecause psychoactive substances reliably shift subjective
experiencesdrug taking is neither a necessary nor a sufficient cause of
addiction. Pathological gambling and excessive sexual behaviors that do not
fall within the domain of obsessive compulsive disorders reveal that
addiction can exist without drug taking. These observations serve to remind
us that the objects of addiction do not fully explain the emergence of
addiction. Consequently, scientists need to develop a model of addiction
that can better account for a more complex relationship between a person who
might develop addiction and the object of their dependence. One strategy for
developing a new model is to emphasize the relationship instead of either
the attributes of the person struggling with addiction or the object of
their addiction.

To emphasize the relationship between the addicted
person and the object of their excessive behavior serves to remind us that
it is the confluence of psychological, social and biological forces that
determines addiction. No single set of factors adequately represents the
multi-factorial causes of addiction (e.g., Shaffer, 1987, 1992; Zinberg,
1984). Unfortunately, the parameters of this unique relationship also are
difficult to define. Therefore, until experience provides more insight into
the synergistic nature of these factors and helps us determine the
interactive threshold(s) that may apply, we are forced to operationalize
addiction so that researchers, clinicians and policy makers can share a
common perspective (Shaffer, 1992; Shaffer & Robbins, 1991; 1995).

Using an Operational Definition: A Simple Behavioral
Model:

In the field of addictions, workers need precise
operational definitions. To avoid confusion, researchers and clinicians have
developed handy operational schemes to reduce inconsistency. One simple
model for understanding addiction is to apply the three Cs:

Behavior that is motivated by emotions ranging along
the Craving to Compulsion spectrum

Continued use in spite of adverse
consequences and

Loss of Control.

Vague definitions of addiction, encouraged Vaillant
(1982) to note that recognizing alcoholism (and perhaps other addictions)
ultimately was similar to identifying a mountain or season; when confronted
with these situations, we know these things implicitly. However useful,
tacit knowledge is insufficient architecture upon which to rest the
advancement of a science.

As a young science, the addictions represents a growing
body of knowledge and a variety of emerging biological and social science
methodologieswith all of the attendant rules and regulations of sciencefor
expanding and verifying the emerging knowledge base. If the field of
addictions is to mature, as have other domains of science, we must
diligently work toward conceptual clarity. To develop theoretical precision,
the field of addictions must escape from the cloak of partisan ideas.
Conceptual clarity does not require that clinicians, researchers and social
policy makers agree. However, it does require that as addiction specialists
we define our concepts and work precisely and operationally. Under these
conditions, treatments and research become replicable. The full tapestry of
addiction patterns begins to emerge. The freedom to explore important issues
develops. Conceptual chaos diminishes and, with all of its inherent debates,
science progresses (e.g., Shaffer, 1986).